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Types of CLA and How It Is Diagnosed

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Cleft Lip and Alveolus (CLA) can be diagnosed through prenatal ultrasound, fetal MRI, or physical exam at birth. It is categorized by laterality (unilateral or bilateral) and completeness (partial notch vs. extending into the nose). Isolated CLA is rarely associated with other health syndromes.

Key Takeaways

  • • CLA can be diagnosed before birth using standard ultrasounds or highly accurate fetal MRIs, as well as during a physical exam at birth.
  • • Clefts are categorized as unilateral (one side, usually the left) or bilateral (both sides).
  • • A complete cleft extends all the way into the nostril floor, while an incomplete cleft is a partial notch in the lip or gum.
  • • Babies born with an isolated cleft lip and alveolus have a drastically lower risk of associated health syndromes compared to those with a cleft palate.

Understanding the specific type of Cleft Lip and Alveolus (CLA) your baby has is a key step in planning for their care. Doctors use imaging and physical exams to determine the “laterality” (which side) and the “completeness” (how far it extends) of the cleft [1][2]. These details help the surgical team create a personalized timeline for your child’s treatment [3].

How CLA is Diagnosed

A diagnosis can happen either before birth through advanced imaging or immediately at birth through a physical examination.

Prenatal Diagnosis

Many parents learn about a cleft during a routine prenatal ultrasound. While standard 2D ultrasound is a common screening tool, it has limitations based on the baby’s position or the amount of amniotic fluid [4].

  • Ultrasound Accuracy: Standard ultrasound has a sensitivity of about 77.5% for identifying facial malformations [5].
  • Fetal MRI: If a cleft is suspected, doctors may recommend a Fetal MRI. This imaging is highly accurate, with a sensitivity of up to 93-100% for cleft lip [6][5]. It provides a much clearer picture, helping doctors confirm that the palate (roof of the mouth) is truly intact [6].

Diagnosis at Birth

If the cleft was not seen during pregnancy, it is diagnosed at birth through a visual assessment. The medical team will look closely at the lip and the alveolus (the gumline) to categorize the cleft [7].

Subtypes of CLA

Your doctor will use specific terms to describe your baby’s cleft. Understanding these terms can help you visualize the anatomy (Note: Your doctor can provide medical illustrations to help demonstrate these differences):

Unilateral vs. Bilateral

  • Unilateral: The cleft is on one side of the lip and gumline. Statistically, unilateral clefts are more likely to occur on the left side [8][9].
  • Bilateral: The cleft occurs on both the left and right sides. Bilateral clefts are often considered more complex for surgical repair because they involve more of the central lip and gum tissue [10].

Complete vs. Incomplete

  • Complete: A complete cleft extends all the way through the lip and the gumline, reaching the floor of the nostril [2]. This can sometimes cause the nose to appear slightly flattened on the affected side [3].
  • Incomplete: An incomplete cleft is a partial gap or “notch” in the lip or gum that does not extend all the way into the nose [11].

Screening for Associated Conditions

When a baby is born with an orofacial cleft, it is standard practice for doctors to perform a full neonatal screening to ensure there are no other underlying health issues.

It is critical to know that isolated CLA has a drastically lower risk of associated syndromes compared to cleft palate. While statistics sometimes state that up to 19% of all clefts have associated congenital heart conditions, that number is heavily skewed by children who have a cleft palate [12][13].

Babies with an isolated CLA are overwhelmingly nonsyndromic (meaning the cleft occurs completely on its own) [14]. The standard screenings (checking the heart, bones, and breathing) are simply a thorough precaution to ensure your baby is completely healthy and ready for their upcoming feeding and surgical milestones [6].

Frequently Asked Questions

How is a cleft lip and alveolus diagnosed before birth?
Doctors often first identify a cleft lip and alveolus during a routine prenatal ultrasound. If a cleft is suspected, they may recommend a fetal MRI, which provides a highly accurate and detailed picture to confirm the diagnosis and check the palate.
What is the difference between a unilateral and bilateral cleft lip?
A unilateral cleft affects only one side of the baby's lip and gumline, most commonly the left side. A bilateral cleft occurs on both the left and right sides and is generally more complex for the surgical team to repair.
What does it mean if my baby's cleft is complete or incomplete?
A complete cleft extends all the way through the lip and gumline, reaching the floor of the nostril. An incomplete cleft is a partial gap or notch in the lip or gum that does not extend all the way into the nose.
Are there other health risks associated with an isolated cleft lip and alveolus?
An isolated cleft lip and alveolus is overwhelmingly nonsyndromic, meaning it usually occurs completely on its own without other health conditions. Doctors perform standard neonatal screenings simply as a thorough precaution to ensure your baby is healthy.

Questions for Your Doctor

  • • Is my baby's cleft unilateral or bilateral, and if unilateral, is it on the left or right side?
  • • Is the cleft considered 'complete' (extending into the nose) or 'incomplete' (a partial gap)?
  • • Has a full neonatal screening been performed to rule out any associated conditions, and can you confirm that the risks are low for isolated CLA?
  • • Does the severity of this specific subtype change the timing of the first surgery?
  • • If this was diagnosed via ultrasound, would a fetal MRI provide more helpful detail for surgical planning?

Questions for You

  • • How did I feel when I first saw the imaging or the diagnosis, and what specific information do I need to feel more prepared?
  • • Is there a family history of clefts or other conditions that I should mention to the geneticist or medical team?
  • • What are my biggest concerns regarding the 'completeness' of the cleft and how it might affect my baby's appearance?

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References

  1. 1

    Eighteen-Year Follow-Up of 160 Consecutive Individuals Born With Unilateral Cleft Lip or Cleft Lip and Alveolus Treated by the Oslo Cleft Lip and Palate Team.

    Mandal E, Filip C, Andersson ME, Øgaard B

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2019; (56(7)):853-859 doi:10.1177/1055665618820753.

    PMID: 30686058
  2. 2

    Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods.

    Kim J, Jeong W

    Archives of craniofacial surgery 2022; (23(2)):53-58 doi:10.7181/acfs.2022.00115.

    PMID: 35526839
  3. 3

    Correlation of vermilion symmetry to alveolar cleft defect in unilateral cleft lip repair.

    Bonanthaya K, Rao DD, Shetty P, Uguru C

    International journal of oral and maxillofacial surgery 2016; (45(6)):688-91.

    PMID: 26754270
  4. 4

    Ultrasound and fetal magnetic resonance imaging: Clinical performance in the prenatal diagnosis of orofacial clefts and mandibular abnormalities.

    Tonni G, Peixoto AB, Werner H, et al.

    Journal of clinical ultrasound : JCU 2023; (51(2)):346-361 doi:10.1002/jcu.23403.

    PMID: 36785498
  5. 5

    Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging.

    Tian M, Xiao L, Jian N, et al.

    Prenatal diagnosis 2019; (39(10)):883-889 doi:10.1002/pd.5499.

    PMID: 31169321
  6. 6

    A Comparison of Early Versus Late Prenatal Magnetic Resonance Imaging in the Diagnosis of Cleft Palate.

    Laifer-Narin S, Schlechtweg K, Lee J, et al.

    Annals of plastic surgery 2019; (82(4S Suppl 3)):S242-S246 doi:10.1097/SAP.0000000000001881.

    PMID: 30855394
  7. 7

    Clefting of the Alveolus: Emphasizing the Distinction from Cleft Palate.

    Wirtz N, Sidman J, Block W

    American journal of perinatology 2016; (33(6)):531-4 doi:10.1055/s-0036-1572537.

    PMID: 26906186
  8. 8

    Cleft sidedness and congenitally missing teeth in patients with cleft lip and palate patients.

    Jamilian A, Lucchese A, Darnahal A, et al.

    Progress in orthodontics 2016; (17()):14 doi:10.1186/s40510-016-0127-z.

    PMID: 27135068
  9. 9

    Frequencies of Different Types of Cleft Lip, Cleft Lip with Palate and Cleft Palate in Bangladeshi Children.

    Begum F, Iqbal M, Nahar N, et al.

    Mymensingh medical journal : MMJ 2019; (28(4)):833-838.

    PMID: 31599248
  10. 10

    Evaluation of Sella Turcica Bridging and Morphology in Different Types of Cleft Patients.

    Alam MK, Alfawzan AA

    Frontiers in cell and developmental biology 2020; (8()):656 doi:10.3389/fcell.2020.00656.

    PMID: 32793599
  11. 11

    Interdental Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patient with Wide Alveolar Cleft.

    Sakamoto T, Ishii T, Sueishi K, Uchiyama T

    The Bulletin of Tokyo Dental College 2020; (61(3)):201-209 doi:10.2209/tdcpublication.2019-0036.

    PMID: 32801263
  12. 12

    The prevalence of non-syndromic orofacial clefts and associated congenital heart diseases of a tertiary hospital in Riyadh, Saudi Arabia.

    AlHammad Z, Suliman I, Alotaibi S, et al.

    The Saudi dental journal 2021; (33(3)):137-142 doi:10.1016/j.sdentj.2019.12.002.

    PMID: 33679106
  13. 13

    Congenital malformations and medical conditions associated with orofacial clefts in children in Burkina Faso.

    Nagalo K, Ouédraogo I, Laberge JM, et al.

    BMC pediatrics 2017; (17(1)):72 doi:10.1186/s12887-017-0833-9.

    PMID: 28292285
  14. 14

    Clinical Characteristics of the Cleft Lip and/or Palate: Association with Congenital Anomalies, Syndromes, and Chromosomal Anomalies.

    Fujii N, Doi R, Narai T, et al.

    Yonago acta medica 2023; (66(4)):440-447 doi:10.33160/yam.2023.11.009.

    PMID: 38028265

This page provides educational information about Cleft Lip and Alveolus (CLA) diagnosis and types. Always consult your pediatric care team or maternal-fetal specialist for medical advice and treatment planning for your baby.

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